BackgroundChildhood obesity is a public health problem worldwide. Visceral obesity, particularly associated with cardio-metabolic risk, has been assessed by body mass index (BMI) and waist circumference, but both methods use sex-and age-specific percentile tables and are influenced by sexual maturity. Waist-to-height ratio (WHtR) is easier to obtain, does not involve tables and can be used to diagnose visceral obesity, even in normal-weight individuals. This study aims to compare the WHtR to the 2007 World Health Organization (WHO) reference for BMI in screening for the presence of cardio-metabolic and inflammatory risk factors in 6–10-year-old children.MethodsA cross-sectional study was undertaken with 175 subjects selected from the Reference Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro, Brazil. The subjects were classified according to the 2007 WHO standard as normal-weight (BMI z score > −1 and < 1) or overweight/obese (BMI z score ≥ 1). Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glycemia, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), Homeostatic Model Assessment – Insulin Resistance (HOMA-IR), leukocyte count and ultrasensitive C-reactive protein (CRP) were also analyzed.ResultsThere were significant correlations between WHtR and BMI z score (r = 0.88, p < 0.0001), SBP (r = 0.51, p < 0.0001), DBP (r = 0.49, p < 0.0001), LDL (r = 0.25, p < 0.0008, HDL (r = −0.28, p < 0.0002), TG (r = 0.26, p < 0.0006), HOMA-IR (r = 0.83, p < 0.0001) and CRP (r = 0.51, p < 0.0001). WHtR and BMI areas under the curve were similar for all the cardio-metabolic parameters. A WHtR cut-off value of > 0.47 was sensitive for screening insulin resistance and any one of the cardio-metabolic parameters.ConclusionsThe WHtR was as sensitive as the 2007 WHO BMI in screening for metabolic risk factors in 6-10-year-old children. The public health message “keep your waist to less than half your height” can be effective in reducing cardio-metabolic risk because most of these risk factors are already present at a cut point of WHtR ≥ 0.5. However, as this is the first study to correlate the WHtR with inflammatory markers, we recommend further exploration of the use of WHtR in this age group and other population-based samples.

SumárioA síndrome metabólica (SM) tem gerado enormes controvérsias, a iniciar-se pela terminologia. O próprio autor que sugeriu o termo, Gerald Reaven, recomenda que não o utilizemos, porque, como a síndrome é um apanhado de alterações metabólicas e três dessas alterações podem defini-la, fica sempre difícil saber-se a que conjunto de alterações estamos nos referindo quando conotamos o termo SM. Em crianças, a complicação é ainda maior, já que se fazem diferentes adaptações aos critérios propostos para adultos. De qualquer forma, independentemente da terminologia, os riscos cardiovasculares são bem estabelecidos e fica cada vez mais claro que as crianças, já em tenra idade, podem começar a ter alterações metabólicas preditivas de problemas mais sérios futuramente. Assim, o papel do endocrinologista pediátrico e do pediatra geral é de investigar essas crianças, especialmente se portadoras de sobrepeso ou obesidade, para detectar precocemente e intervir em condições que podem ser prevenidas na vida adulta. Essa é uma nova visão de uma abordagem pediátrica preventiva de problemas que, usualmente, só são diagnosticados em vida adulta. Nesta revisão, abordamos os aspectos de definição, epidemiologia, fisiopatologia e de complicações da SM em crianças e adolescentes.Arq Bras Endocrinol Metab. 2011;55(8):576-82 Descritores Síndrome metabólica; dislipidemia; resistência à insulina; hipertensão arterial sistêmica; esteatose hepática; índice de massa corpóreo SummArYMetabolic syndrome (MS) has been a condition involved in considerable controversy, starting with the terminology. Gerald Reaven himself, the author who proposed the term MS, advised against the use of this terminology because the definition implies in at least three metabolic alterations, and it is never clear to which group of alterations we are referring to when we say that a patient has MS. In children, the problem is even more complicated, since there are many different adaptations to the criteria used in adults. On the other hand, independent of the terminology, cardiovascular risks are well-established and it is very clear that even children may present metabolic disturbances which predict future metabolic problems. The role of the pediatric endocrinologist or the general pediatrician is to investigate, especially in overweight/ obese children, conditions that if treated early, may prevent future complications that today, unfortunately, are being diagnosed only in adult life. In this review, we discuss problems on the definition, epidemiology, pathophysiology, and complications of MS in children and adolescents. Arq Bras Endocrinol Metab. 2011;55(8):576-82

RESUMOObjetivo: Avaliar a sensibilidade insulínica e o perfil metabólico em portadoras de SOP com peso normal e sobrepeso/obesas. Material e Méto-dos: Foram avaliadas, retrospectivamente, 49 pacientes, entre 18 e 45 anos, divididas em 2 grupos, conforme o índice de massa corporal (IMC): grupo 1 (18,5-24,9 kg/m 2 ) e grupo 2 (25-40 kg/m 2 ). Dados coletados: pressão arterial sistólica (PAS) e diastólica (PAD); valores basais e após TOTG da glicose, insulina, e da relação glicose/insulina; área sob a curva para glicose e insulina; HOMA-IR, HOMA-β; perfil lipídico; testosterona total (T) e livre (TL (49) patients from 18 to 45 years were retrospectively evaluated and divided into 2 groups, according to the body mass index (BMI): group 1 (18.5-24.9 kg/m 2 ) and group 2 (25-40 kg/m 2 ). Colected data: systolic and dyastolic blood pressure; fasting and after OGTT glucose, insulin and glucose/insulin ratio; area under the curve for glucose and insulin; HOMA-IR and HOMA-β; lipidic profile; free (FT) and total testosterone (T) levels. Results: Greater averages of pressoric levels, insulin resistance (IR) indices, triglycerides and the FT levels, in adition to lower HDL levels, were found in group 2. Neither correlation between the IMC with none of data nor of the FT and IR indices with the lipid profile were found. Conclusions: Obesity is associated with insulin resistance and diabetes mellitus in PCOS, independently on familiar history of DM. The absence of correlation between the IR indices and the FT with the lipidic profile suggests that other factors, such as the free fatty acids, can be involved in the pathogenesis of dyslipidemia in PCOS.

Both HRT groups showed a reduction in their Framingham score. In contrast to data from other HRT investigations on cardiovascular risk, these formulations proved to be safe, even in the first year of use.

RESUMOApós o tratamento inicial do câncer tireoidiano, a detecção de prováveis recorrências e/ou metástases se faz através da dosagem de marcadores séricos e estudos de imagem. Essas técnicas podem ser negativas apesar de evidências bioquímicas de doença metastática. A tomografia de emissão de pósitrons com fluorodeoxiglicose (FDG-PET) tem sido proposta como um teste acurado para detectá-la. O objetivo deste estudo é apresentar uma síntese das evidências obtidas através de revisão sistemática sobre a acurácia do FDG-PET na localização de metástases de câncer tireoidiano previamente tratado, nos quais as modalidades convencionais falharam na sua detecção. Foi realizada uma pesquisa bibliográfica no MEDLINE de todos os trabalhos relativos a FDG-PET e carcinoma tireoidiano diferenciado, indexados até setembro de 2005. Foram obtidas 216 citações e 17 trabalhos foram incluídos, 71% publicados a partir de 2000. A sensibilidade da FDG-PET foi elevada, com apenas um trabalho apresentando sensibilidade inferior a 75%. A especificidade, examinada em 12 estudos, foi menor que 75% em 3 estudos. Em 41% dos trabalhos existia pelo menos um teste comparativo com o FDG-PET. Os resultados apontam o FDG-PET como um teste diagnóstico útil para a detecção e localização de metástases do câncer tireoidiano, com implicações diretas no tratamento dos pacientes. ABSTRACT Utility of Positron Emission Tomography with Fluorodeoxyglucose (FDG-PET) in the Evaluation of Thyroid Cancer: a Systematic Review.After the initial thyroid cancer treatment, the detection of likely recurrences and/or metastases is made through the measurement of serum markers determinations and diagnostic image procedures. These techniques may be negative in spite of biochemical evidence of metastatic disease. The positron emission tomography with fluorodeoxyglucose (FDG-PET) has been proposed as an accurate method to detect it. The aim of this study is to present a synthesis of the evidences obtained from a systematic review regarding FDG-PET accuracy in locating suspected metastases of previously treated thyroid cancer, when the conventional methods failed to do it. A bibliographic review of all studies related to FDG-PET and differentiated thyroid cancer was made on MEDLINE, indexed until September 2005. Two hundred and sixteen citations were collected and 17 studies included, 71% were published after 2000. FDG-PET sensibility was high, with only one study presenting a sensibility lower than 75%. The specificity, examined in 12 studies was lower than 75% in 3 studies. There was at least one test compared to FDG-PET in 41% of the studies. The results point to FDG-PET as a useful diagnostic test to detect and localize thyroid cancer metastases, with direct implications in the treatment of these patients.